Registration Form New Jersey Dental Society of Anesthesiology

Transcription

Registration Form New Jersey Dental Society of Anesthesiology
presents
New Jersey Dental Society of
Anesthesiology
by
The Eyes Don’t See What The Mind Does
Not Know!
on
Wednesday, May
6th,
2015
at
Grand Marquis
1550 Route 9 South
Old Bridge, NJ 08857
732-679-5700
Name:_____________________________________
Name:_____________________________________
Name:_____________________________________
Address:___________________________________
City:______________________________________
State:___________ Zip:______________________
Phone:____________________________________
E-mail:____________________________________
● NJDSA/ADSA member
____ @ $150 =$_____
● Non- member
____ @ $200 =$_____
● Nurse, Assistant, Staff
____ @ $65 =$_____
● Resident and Retired Member
____ @ $65 =$_____
(no CE credits will be given)
● Exhibitor (two representatives with two
tables per company) ____ @ $500 =$_____
Registration Deadline: April 27th, 2015
Late Fee: $25
Grand Total Enclosed …………….……...…=$_____
Please detach, make check payable to NJDSA,
and mail to:
New Jersey Dental Society of Anesthesiology
c/o Petar Hinic, DDS
155 Summit Ave
Summit, NJ 07901
Please call if you have any questions:
Petar Hinic, DDS
Office 908-273-5451
Fax 908-273-9474
by
Deepak G. Krishnan, DDS
on
Wednesday, May 6th, 2015
at
Grand Marquis
1550 Route 9 South
Old Bridge, NJ 08857
732-679-5700
From New York
NJ Turnpike South Exit 11 (Garden State Parkway).
Take GSP South to exit 123 (Rt. 9 South). Passing all
toll booths, stay to right (local lanes). Grand Marquis is
located 3 miles south on Rt. 9 on the right hand side of
the highway.
From Staten Island, Long Island, Brooklyn
Belt Parkway to Verrazano Bridge. Rt. 278 to Rt. 440
to Outer Bridge to NJ. Follow signs to Garden State
Parkway South to Exit 123, to Rt. 9 South. Grand
Marquis is located 3 miles south on Rt. 9 on the right
hand side of the highway.
From Philadelphia, Camden
Walt Whitman Bridge to NJ Turnpike North to Exit 8.
Take highway 33 East until highway splits, bear right to
Rt. 9 North. Proceed approx. 15 miles, make U-turn
on Old Mill Road. Grand Marquis is on the South side
of Rt. 9.
From South Jersey
Garden State Parkway to exit 120. Make a right at the
end of the ramp. Make a right at first traffic light. Go
to end and make a left. Go to end and make a right
onto Rt. 34 North. Follow Rt. 34 North to Rt. 9
South. Take Rt. 9 South to Grand Marquis, located at
the 2nd traffic light, on the right.
CORRECT ADDRESS REQUESTED
FORWARDING ADDRESS REQUESTED
Deepak G. Krishnan, DDS
presents
c/o Petar Hinic, DDS
155 Summit Avenue
Summit, NJ 07901
The Eyes Don’t See What The Mind Does
Not Know!
New Jersey Dental Society of Anesthesiology
New Jersey Dental Society of
Anesthesiology
Place Stamp
Here
Registration Form
Deepak G. Krishnan, DDS
Deepak Krishnan is an American
Board
certified
Oral
&
Maxillofacial Surgeon and the
Residency Program Director at
University
of
Cincinnati’s
advanced training program in
Oral & Maxillofacial Surgery. He
is an associate professor of
Surgery at the College of
Medicine at University of
Cincinnati where he teaches and
practices.
Deepak obtained his dental degree from Bangalore
University, India and pursued formal training in Oral and
Maxillofacial Surgery in Emory University’s College of
Medicine in Atlanta, Georgia. Upon completion of the
residency, Deepak pursued further fellowship training in Oral
& Maxillofacial Surgery focusing on orthognathic surgery at
Dalhousie University, Halifax, Canada.
Deepak’s clinical interests are in Orthognathic and
reconstructive surgery, maxillofacial trauma, pediatric
maxillofacial surgery, ambulatory anesthesia and clinical
research and simulation.
He currently serves on the Committee on Anesthesia and
Special Committee for Clinical Research of the AAOMS and
is the chairman of the Trainee Section of the International
Association of Oral and Maxillofacial Surgeons. He is the
president of the Ohio Dental Society of Anesthesia and the
president-elect of the Ohio State Oral and Maxillofacial
Surgeons.
The Eyes Don’t See What The Mind Does
Not Know!
A practice of safe anesthesia begins with intent training, acute
awareness of the unexpected and a constant air of caution expecting the worst to happen at any given moment and
being prepared to manage it. The practitioner must train, retrain and review the fundamental principles of his actions,
and their reactions, periodically and repetitively. Newer drugs,
changing standards and emerging technology force us to
deviate from our habits and routines onto paths we have not
taken before. A thorough understanding of potential
complications and a rigorous training in management of the
potential complications save lives.
-continued on next page-
The series of lectures is aimed to provide basic as well as indepth understanding of intra-operative complications related
to administration of anesthesia, their management and, more
importantly, their avoidance in our unique practice setting.
An effective strategy in preparing for the unexpected is
simulating and practicing emergency scenarios.
An ounce of prevention and a pound of cure!
Please visit our website one week prior to the
meeting to download the lecture handout:
WWW.NJDSA.ORG
Course Outline
Wednesday, May 6th, 2015
8:15 – 9:00 Registration and Continental Breakfast
9:00 – 12:30 Morning Lecture
12:30 – 1:30 Lunch
1:30 – 5:00 Afternoon Lecture
5:00 – 5:30 Business Meeting (open to all members
regardless of meeting attendance)
This NJDSA Course offers seven (7) Continuing
Education credit hours for NJ Dental License renewal
and 35 NJ Anesthesia Permit Renewal Credits.
Please check your individual requirements.
This course is suitable for Oral and Maxillofacial
Surgeons, Dental Anesthesiologists, Anesthesia
providers, office staff and assistants.
Please check your membership status on address field
of this mailing (member vs. non-member). You will
be registered as a non-member if you are not on the
ADSA membership list.
Your office anesthesia evaluation must be performed
every six years. You are responsible to have it
completed and to send the evaluation report to the
State Board of Dentistry.
To receive the full seven (7) credit hours, a course
evaluation form will be provided at lunch hour to be
completed and signed by the attendee and must be
submitted to the reception desk so as to compliment
the a.m. sign in. If you only have signed in the a.m.,
only four (4) credit hours will be issued. Certificate of
attendance will be mailed to the attendee after the
correlation of signatures.
Save the Date – Future Meeting
October 7th, 2015 Scientific Session
Speaker and Topic to be Determined
New Jersey Dental Society of Anesthesiology
AED Rebate Program
 The AED rebate program is available only to regular
NJDSA members who have paid full membership dues for
the year prior to their request.
 Documentation will need to be provided from the ADSA’s
web site to show the active member status of the rebate
applicant.
 A copy of a paid receipt for a new AED will need to be
provided, not for reprogramming of an older model or a
supplies purchased.
 A photograph or photocopy of the back of the new AED
needs to be provided showing the unit’s serial number to be
verified on the purchase receipt.
 One AED rebate per member per year.
Sim Man & Anesthesia Assistant Incentives
 The tuition stipend program is available only to regular
NJDSA members (or their assistant employees) who have
paid full membership dues for at least one the year prior to
their request for this member benefit.
 A tuition stipend of:
- $100 is contingent upon the doctors successful
completion of a “Sim Man” course provided through the
ADSA
- $75 is contingent upon the successful completion of the 2
day anesthesia assistant course provided through the ADSA
 Documentation will need to show that full course tuition
was paid to the ADSA for the course.
 The applicant needs to provide a copy of the certificate
showing successful course completion with the awarding of
4-4.5 hours of CE credits for the “Sim Man” course or the
CE certificate of completion in the case of the anesthesia
assistant program.
 One each tuition stipend per member.
Please send Rebate & Incentive information by mail
only to:
Lee M. Lichtenstein, DMD
723 North Beers Street
Holmdel, NJ 07733
NJDSA Executive Committee
President – Dr. John Feeney
Vice President – Dr. Petar Hinic
Treasurer – Dr. Martin Kaminker
Secretary – Dr. Petar Hinic
www.njdsa.org